"Under the health care overhaul, the federal government will start taxing itself and the states beginning in 2014. And that's giving state Medicaid directors heartburn. A report released Tuesday by the actuarial firm Milliman Inc. said the tax will cost the Medicaid program between $36.5 billion and $41.9 billion over 10 years. At least $13 billion will be borne by states, and at least $23.5 billion by the federal government, based on the state-federal Medicaid matching formula."
"That is, states must now accept a comprehensive reorganization of Medicaid or forfeit all federal Medicaid funding—even though the spending power is circumscribed to preserve a distinction between what is local and what is national. If Congress is allowed to attach conditions to spending that the states cannot refuse in order to achieve an objective it could not outright mandate, the local/national distinction that is so central to federalism will be erased."
"Twenty-six states on Tuesday asked the Supreme Court to overturn the health care reform law’s mandatory state expansion of the Medicaid program, a sleeper issue in the health care reform lawsuit that could determine how much leverage the federal government has with the states on any issue. The states, led by Florida, argue that the federal government can’t force them to expand the Medicaid program, which has operated as a partnership between the feds and the states, as part of the 2010 health reform law. They argue that the Medicaid expansion is possibly more coercive than the law’s individual mandate."
"Lawyers on both sides of the lawsuits over President Obama’s healthcare law were caught off guard Monday when the Supreme Court said it would debate whether the law’s Medicaid expansion is constitutional. The high court was widely expected to take up the law’s individual mandate, and to take the case filed by 26 states and the National Federation of Independent Business. But the court’s decision to also hear the states’ Medicaid challenge came as a surprise to the healthcare law’s critics as well as its supporters."
"As demand outstrips supply we can expect large increases in waiting time for services and a price war for providers between Medicaid and commercial insurers. Regardless of the administration’s arguments, little in the Affordable Care Act (ACA) addresses this dynamic. Increases in primary care physician fees, funding for Federally Qualified Health Centers, and national health services corps slots don’t build any new physician capacity; they only drive more competition for limited physicians and fuel a price war. It is likely the administration is relying on the Independent Payment Advisory Board and their new premium rate review power over private insurance to try to control prices, but waiting lines and an increased reliance on the emergency room will be a new fact of life."
"But researchers at Harvard University are now warning that policymakers should be prepared for substantial uncertainty about the true enrollment effects of the Medicaid expansion. In a paper published in the journal Health Affairs earlier this week, a team of health economists estimated that, under the law, new Medicaid enrollment could be as low as 8.5 million people, but also as high as 22.4 million people—with additional costs to match."
"Even with ObamaCare set to inflate the Medicaid rolls, reimbursement rates are falling further. When the NBER investigated Oregon’s program, the state paid doctors 90% of Medicare rates — more than most other states. But since then, Oregon, as well as nearly half its peers, has cut payments. More doctors will doubtless leave the program as a result. This supply problem is one reason the NBER study specifically cautioned against extrapolating its results to model ObamaCare’s expansion of Medicaid. Under ObamaCare, one in four Americans will be covered by Medicaid at a total cost of nearly a trillion dollars. They may receive subpar care — or may not even be able to get an appointment with a doctor. But as the NBER report shows, at least they’ll have a 'general sense of improved well-being.'"
"Another unintended consequence of President Barack Obama's health care law has emerged: Older adults of the same age and income with similar medical histories could pay widely different amounts for private health insurance due to a quirk of the complex legislation. Those differences could be substantial. A 62-year-old could end up paying $1,200 a year more than his neighbor, in one example. And experts say the disparities among married couples would be much larger."
"[D]ue to a glitch in Obamacare, married couples of early retirees making around $64,000 a year will become eligible for Medicaid. That’s more than four times the federal poverty level of $14,710... If we do a back-of-the-envelope calculation, in which the average annual Medicaid expenditure per early retiree is $15,000 per year, the ten-year cost of this glitch could be as high as $450 billion. Even if only half of those eligible opt to take advantage of the loophole, we’re talking at least $250-300 billion, as the sickest patients are the ones most likely to enroll."
"Children with Medicaid are far more likely than those with private insurance to be turned away by medical specialists or be made to wait more than a month for an appointment, even for serious medical problems, a new study finds. Lower payments by Medicaid, delays in paying and red tape are largely to blame, researchers say. The study, with findings that match anecdotal reports from other parts of the country, is one of only a few efforts to measure access to health care among people with Medicaid. Nationwide, those patients are caught between states’ threats to cut Medicaid payments and the Obama administration’s plans to use the program to cover more and more people as part of its health care law."
